Part One | Part Two | Part Three
By: Jean Johnson for Uterus1
Like diagnosis, treatment of menorrhagia is not straight-forward, and practitioners must weigh a number of factors including the condition and history of a woman’s general health, the severity and cause of the heavy bleeding and the patient’s tolerance for various treatment approaches. Indeed, women that are informed about the general medications, therapies and procedures available for treating heavy bleeding can enter into the conversation more ably with their healthcare providers – and thus have increased chances of a satisfying experience in which they feel they have participated in decisions related to their well-being in a dignified manner.
|Be an active participant in your healthcare: |
Get involved in your medical treatment by working closely with your physician.
Stay informed on all aspects of your condition, diagnoses and treatment options including those provided by various specialists.
Weigh decisions carefully after consulting with trusted family members or friends.
Know that most insurance companies cover second opinions.
Have blood count and iron levels measured at least annually and consider iron supplements if your physician advises.
• Oral Contraceptives
For women who are not opposed to contraceptives, going on the pill is often recommended to stem menorrhagia associated with irregular ovulation and even fibroids. In Lori Rice’s case, even though her father was reluctant to have his teenage daughter on the pill, the young woman from Pittsburgh can’t speak highly enough about the treatment. Before she went on the pill she says life was exceedingly difficult to manage.
“One time I was in class and in so much pain, the teacher let me go lie down on the heater in the back of the classroom,” Rice said. After she started on the low dose birth control pills, though, symptoms that had interfered with her daily life for years improved markedly. “I still have some cramping, but I can go to school,” she said. “I used to be very mean that time of month. Now, my mood swings have changed. They only thing taking the pill hasn’t done that it was supposed to is clear up my skin, but I hope it will.”
Although Rice is pleased with the immediate results, her mother and physicians are mindful that the jury is still out on how widely birth control pills should be used to treat heavy bleeding and its associated pain and cramping in young women. According to Columbia-Presbyterian Medical Center physician, Anne Davis, M.D. who studied using contraceptives to treat adolescents, dealing with symptoms is in part a function of age. “Older women probably cope a little better,” said Davis. Between that and questions related to the long-term effects of taking birth control pills – even low dose ones – experts tend to be cautious in their use.
• Prostaglandin inhibitors
This group of over-the-counter drugs, called nonsteriodal anti-infammatory medicine or Ibuprofen are sold under generic brands as well as popular labels including Advil and Motrin. Prostaglandin inhibitors help decrease cramping and blood flow to some degree in many patients, and because these drugs are available without prescription, women often turn to them first to try and manage menorrhagia.
Patients with prolonged symptoms that consult a healthcare professional, however, are generally better served since physician diagnosis can often identify a cause and determine if additional therapy is appropriate. In short, the body is complex and getting advice from those who have spent years studying its workings is usually a wise move.
• Iron supplements
Even blood loss associated with normal menstrual flow can produce anemia and so women who have heavy bleeding are often treated with iron. Supplements are used to both restore levels in patients that are anemic as well as a prophylaxis to forestall potential anemia.
• Dilation and Curettage (D and C)
Dilation and curettage can help relieve heavy bleeding by removing part of the thickened uterine lining.
• Operative hysteroscopy
An operative hysteroscopy uses the telescopic equipment, and the technique can be used as a diagnostic tool. Used as a treatment, though, this procedure is aimed at assisting in the surgical removal of uterine polyps that might be the source of the menorrhagia.
• Endometrial ablation
This technique permanently destroys the lining of the uterus and thus is appropriate only for women who have had all the children they want. Ablation is defined as removing material from the surface of something, and in this case it is the interior of the uterus.
The story below from Maureen that we found on the anonymous chat group at obgyn.net describes one woman’s experience with ablation. Although Maureen also has endometriosis, a painful condition caused when tissue similar to the lining of the uterus is found in other parts of the body, one of her symptoms was heavy bleeding.
“I had an endometrial ablation in January 1998. I have endometriosis and also had a large fibroid tumor. I had very heavy periods with huge clots, and lots of pain. My doctor was not sure whether she would be able to successfully remove the fibroid, since none of the tests really show exactly where it is. She recommended doing an ablation at the same time to improve the periods.”
“Essentially, an endometrial ablation removes the interior of the uterus – the endometrial lining. It's not the same as a D&C, which just scrapes. This procedure actually removes the endometrium – which is what swells up and bleeds every month. No endometrium, no bleeding. In theory, at least. And until it grows back. The procedure did nothing for my endometriosis, nor did my doctor say that it would. She did say that some of the cramping was coming from the amount of blood that I was passing, so to the extent that I would no longer be bleeding in the uterus, the cramping and pain would be reduced.”
“It turns out that I had both the endometrial ablation and she successfully removed the entire fibroid. IT WORKED! Yes I still have endo pain and I still have periods, but the actual bleeding is more like spotting - I guess it's impossible to get it all, and it's probably growing back anyway. The doctor mentioned something like two years to grow back the endometrial lining, and it's been nearly one year so far. I was just about hemorrhaging every month so now at least I am just dealing with the endo pain.”
As Maureen observed, there is no guarantee that treatment other than a hysterectomy will permanently end heavy bleeding. But, removal of the uterus and cervix is major surgery from which recovery is a considerable feat that can last for months. In addition to simply recuperating from having an abdominal incision and all that accompanies that type of invasion into the body, the cessation of menstrual periods and the onset of menopause brings its own massive set of adjustments. Indeed, hysterectomy is the only treatment of those listed above that must be performed in a hospital under a general anesthetic.
The good news, though, is that since alternative methods for treating heavy bleeding have gained credibility in recent years, fewer women suffering from menorrhagia are forced into hysterectomies. Instead, by working with their physicians, patients can explore a range of approaches best suited for their particular age and circumstances. That increasing numbers of women have found relief with the range of technologies that have been developed to treat heavy bleeding is cause for hope in those that still suffer. Clearly, gone are the days when women had to suffer in silence.
If you enjoyed this article, you might also be interested in the following:
Surgery and IUD Produce Similar Patient Results for Heavy Periods
IUD Device Doubles as Treatment for Heavy Periods
Women With Heavy Periods Express Concern About Symptoms, Treatment Options
Less Invasive Treatment for Excessive Uterine Bleeding